Similar Drugs

Ramipril is the generic version of the brand-name drug Altace, which is used to treat high blood pressure (hypertension).

Ramipril also reduces the risk of a heart attack, stroke, and death in people age 55 and older and at high risk of a major cardiovascular event.

It also improves survival when a person's heart is not able to pump enough blood to the body (congestive heart failure) after a heart attack.

Ramipril is in a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by keeping blood flowing smoothly throughout the body.

Doctors sometimes prescribe ramipril off-label to treat people with other health conditions, such as kidney issues associated with scleroderma (hardening and thickening of the skin), diabetes, and the genetic disorder Alport syndrome.

The FDA approved Ramipril in 1991. Pfizer manufactures the drug.

In 2012, the consumer watchdog group Public Citizen petitioned the FDA to add black-box warnings cautioning against the use of three hypertension drugs (when used together)- ACE inhibitors, including ramipril; angiotensin II receptor blockers (ARBs); and aliskiren (Tekturna) - because studies show that they can combine to cause kidney failure, low blood pressure, and hyperkalemia (elevated blood potassium levels).

However, ramipril doesn't currently have a black-box warning against its combined use with other hypertension drugs.

Ramipril Warnings

The package insert that comes with your ramipril prescription has a black-box warning cautioning users that the drug may cause harm and death to a developing fetus. Do not take ramipril if you are pregnant or plan on becoming pregnant.

People who are hypersensitive to ACE inhibitors should not use ramipril. Additionally, people with diabetes or kidney impairments should not take ramipril at the same time as aliskiren (Tekturna).

The use of ACE inhibitors, including ramipril, has been associated with the following health problems:

An increased risk of angioedema (swelling under the skin) in people with a prior history of the condition or people taking mTOR inhibitors (a class of anti-cancer medications). Depending on where it occurs, it can cause pain, and difficulty swallowing and breathing.

Impaired liver function and failure

Impaired kidney function

Neutropenia and agranulocytosis (conditions associated with low counts of neutrophils, a type of white blood cell)

Hypotension

Hyperkalemia

Pregnancy and Ramipril

Ramipril is a Pregnancy Category D drug, meaning that there is evidence that it can harm a developing fetus, particularly when taken during the second and third trimesters.

Drugs like ramipril can reduce the kidney function of the unborn baby, as well as cause poor development of the baby's lungs and bones.

Ramipril is also associated with numerous other problems for newborns, including death. Ramipril should not be taken if you are pregnant or plan on becoming pregnant.

Ramipril is excreted in human breast milk and should not be taken if you are breastfeeding.

Ramipril (Altace) Dosage

The capsules should be taken whole. If you have difficulty swallowing the capsule, you can open it and sprinkle the drug contents onto a small amount (about 4 ounces) of applesauce, or mix it into 4 ounces of water or apple juice.

If you have high blood pressure, your doctor will prescribe an initial, daily dose of 2.5 mg to 20 mg. After 2 to 4 weeks, the dosage is usually adjusted according to how your blood pressure responds to the medication.

If you are taking ramipril to reduce your risk of a major cardiovascular events, your doctor will likely prescribe a daily dose of 2.5 mg for one week, then 5 mg once daily for three weeks, and finally 10 mg once daily if you tolerate the drug well.

If you've had a heart attack, your doctor may prescribe 2.5 mg of ramipril twice daily to prevent heart failure. Your doctor may decrease the dose by half if the drug causes your blood pressure to drop too low.

If you are tolerating the drug, you can expect a dose increase every three weeks until you are taking 5 mg of ramipril twice a day.

Dosages may differ for people with impaired kidney function or who are dehydrated.

Ramipril Overdose

A ramipril overdose can cause hypotension, making you feel lightheaded and possibly faint.

Contact a poison control center or emergency room if you suspect you've taken too much ramipril. You can get in touch with a poison control center at (800) 222-1222.

Call 911 if someone has collapsed or is not breathing from a possible ramipril overdose.

Missed Dose of Ramipril

Take your missed dose of ramipril as soon as possible.

If it's almost time for your next dose, skip the missed dose and continue on your regular dosing schedule. Don't double up on doses to make up for a missed one.

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